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    Senior Citizen Applicationform

    Uploaded by

    Johven Ramirez
    This document contains an application form and information sheet for senior citizens in Barangay San Antonio, Pasig City to apply for a white card. The application requests the applicant's personal details such as name, address, date of birth, contact number, and requirements like ID photos and birth certificate. The information sheet collects additional details about the applicant's living situation, health, employment history, and willingness to participate in senior citizen association activities. The forms are used by the Office of the Senior Citizens Affairs to issue white/blue cards to qualified senior citizen residents of Barangay San Antonio.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Senior Citizen Applicationform

    Uploaded by

    Johven Ramirez
    3K views2 pages
    This document contains an application form and information sheet for senior citizens in Barangay San Antonio, Pasig City to apply for a white card. The application requests the applicant's personal details such as name, address, date of birth, contact number, and requirements like ID photos and birth certificate. The information sheet collects additional details about the applicant's living situation, health, employment history, and willingness to participate in senior citizen association activities. The forms are used by the Office of the Senior Citizens Affairs to issue white/blue cards to qualified senior citizen residents of Barangay San Antonio.

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    This document contains an application form and information sheet for senior citizens in Barangay San Antonio, Pasig City to apply for a white card. The application requests the applicant's personal details such as name, address, date of birth, contact number, and requirements like ID photos and birth certificate. The information sheet collects additional details about the applicant's living situation, health, employment history, and willingness to participate in senior citizen association activities. The forms are used by the Office of the Senior Citizens Affairs to issue white/blue cards to qualified senior citizen residents of Barangay San Antonio.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    3K views2 pages

    Senior Citizen Applicationform

    Uploaded by

    Johven Ramirez
    This document contains an application form and information sheet for senior citizens in Barangay San Antonio, Pasig City to apply for a white card. The application requests the applicant's personal details such as name, address, date of birth, contact number, and requirements like ID photos and birth certificate. The information sheet collects additional details about the applicant's living situation, health, employment history, and willingness to participate in senior citizen association activities. The forms are used by the Office of the Senior Citizens Affairs to issue white/blue cards to qualified senior citizen residents of Barangay San Antonio.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Republic of the Philippines

    City of Pasig

    OFFICE OF THE SENIOR CITIZENS AFFAIRS (OSCA)


    www.pasigcity.gov.ph

    SENIOR CITIZENS APPLICATION FORM


    BARANGAY: SAN ANTONIO, PASIG CITY Date: ________________________

    Note: PLEASE PRINT

    GIVEN NAME:

    MIDDLE NAME:

    SURNAME:

    COMPLETE ADDRESS (Number, Street or Purok, Barangqay) CONTACT NUMBER:

    DATE OF BIRTH: AGE: PLACE OF BIRTH:

    RELIGION: BLOOD TYPE: CIVIL STATUS: GENDER: NO. OF YRS IN PASIG CITIZENSHIP

    REQUIREMENTS:
     2 PCS 1X1 PICTURE
     XEROX COPY BIRTH CERTIFICATE/BAPTISMAL
     COMELEC CERTIFICATION
     BARANGAY CLEARANCE
     CEDULA (LATEST) XEROX COPY
    Other supporting Documents: Any Valid ID
    (SSS, PRC, GSIS, TIN, PASSPPORT, POSTAL ID)
    THUMBMARK SIGNATURE OVER PRINTED NAME OF APPLICANT

    CERTIFIED BY:

    ______________________________________________
    PRESIDENT – SENIOR CITIZEN ASSOCIATION

    REMARKS: ISSUED BY: DATE ISSUED: RECEIVED BY:

    New : _________________

    Lost : _________________

    Change : _______________

    Transfer : ______________
    SENIOR CITIZEN INFORMATION SHEET
    BARANGAY SAN ANTONIO, PASIG CITY
    (for White Card Application Only)

    _______________________________________________________________________________________________
    DO NOT FILL THIS SPACE

    Application No. ________________ Date: ___________________ White Card No. _________________ Issued: ______________

    Blue Card Application No. ______________ Date: _______________ Blue Card No. ______________ Issued: ________________
    _________________________________________________________________________________________________________
    PLEASE FILL UP THIS FORM COMPLETELY

    NAME OF SENIOR CITIZEN:

    ________________________________________________________________________________________________________
    Last Name First Name Middle Name

    HOME ADDRESS:

    _________________________________________________________________________________________________________

    BIRTHDATE: _____________________ AGE: ___________________ PLACE OF BIRTH: ___________________________________

    CONTACT NUMBERS

    __________________________ ___________________________ ________________________________


    Land Line Mobile Number E-mail Address (if any)

    No. of Years Residing in Brgy. San Antonio: ______________ Reg. Voter in Brgy. San Amtomio? ( ) YES ( ) NO

    RETIRED? ( ) YES ( ) NO

    If nor Retired, NAME OF EMPLOYER: ________________________________ POSITION: _________________________________

    If Retired, NAME OF LAST EMPLOYER: ______________________________ POSITION: __________________________________

    If Self Employed, NATURE OF BUSINESS: ________________________________________________________________________

    LIVING ARRANGEMENT: ALONE ( ) WITH SPOUSE ( ) WITH OTHERS ( )

    STATE OF HEALTH: EXCELLENT ( ); GOOD ( ); POOR ( )

    Are you willing to actively participate in the activities of the association? ( ) YES ( ) NO

    IF YES, WHAT INTEREST, ACTIVITIES OR ADVOCACY WOULD YOU LIKE TO PARTICIPATE IN? PLEASE SPECIFY

    _____________________________________________________________________________________________________

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